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Importance and accuracy of intraoperative frozen section diagnosis of the resection margin for effective carmustine wafer implantation

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Abstract

For effective implantation of carmustine (BCNU) wafers, it is important to determine the order of priority with reference to the intraoperative frozen section diagnosis of the resection margin (IOFM). The accuracy of IOFM and patterns of tumor recurrence with implantation of BCNU wafers were studied retrospectively. Forty-six cases of newly diagnosed malignant glioma were evaluated. Tumors were resected after intraoperative frozen section diagnosis (IOFD). IOFM was performed for resection walls and evaluated on a three-level scale (−, no tumor invasion; 1+, minor cell invasion; 2+, evident cell invasion). The results were used for effective BCNU wafer implantation. The IOFM sections were then thawed, frozen-paraffin marginal (FPM) sections were prepared, and IOFM was evaluated with FPM sections. The accuracy of IOFD grading was compared to that of the formalin fixed paraffin-embedded section and was 76.1%. The accuracy of IOFM was compared with the FPM section in 148 specimens from 42 patients. The IOFM accuracy was 80.4%. BCNU wafers were implanted in 25 patients and there was recurrence in 15. Local recurrence was seen in 40% (6 patients). However, there was no recurrence immediately below the BCNU wafers. With properly performed IOFM, BCNU wafers can be efficiently implanted, and local recurrence immediately below the BCNU wafers can be inhibited.

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Abbreviations

BCNU:

Bis-chloroethylnitrosourea

IOFD:

Intraoperative frozen section diagnosis

IOFM:

Intraoperative frozen section diagnosis of the resection margin

IDH:

Isocitrate dehydrogenase

5-ALA:

5-Aminolevulinic acid

TMZ:

Temozolomide

IFN-β:

Interferon-β

BEV:

Bevacizumab

FPM section:

Frozen-paraffin marginal section

FFPE section:

Formalin fixed paraffin-embedded section

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Authors and Affiliations

  1. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori, 036-8562, Japan

    Kenichiro Asano, Kosuke Katayama, Kiyohide Kakuta, Toshio Fumoto & Hiroki Ohkuma

  2. Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori, 036-8562, Japan

    Akira Kurose, Akihisa Kamataki, Noriko Kato & Kaoru Ogawa

Authors
  1. Kenichiro Asano
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  2. Akira Kurose
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  3. Akihisa Kamataki
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  4. Noriko Kato
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  9. Hiroki Ohkuma
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Correspondence to Kenichiro Asano.

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Asano, K., Kurose, A., Kamataki, A. et al. Importance and accuracy of intraoperative frozen section diagnosis of the resection margin for effective carmustine wafer implantation. Brain Tumor Pathol 35, 131–140 (2018). https://doi.org/10.1007/s10014-018-0320-5

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  • DOI: https://doi.org/10.1007/s10014-018-0320-5

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